Bio: A Guy is an academic researcher from University of Birmingham. The author has contributed to research in topics: Thrombus & Ruptured Aortic Aneurysm. The author has an hindex of 1, co-authored 1 publications receiving 31 citations.
TL;DR: Serum lactate and base deficit are markers of tissue ischaemia and are used to assess the adequacy of resuscitation in patients undergoing repair of ruptured abdominal aortic aneurysm (AAA), demonstrating that an immediate post-operative serum lactate or base deficit < or =-7 mmol/l are good predictors of outcome after ruptured AAA repair.
TL;DR: The hypothesis that the presence of ILT in AAA correlates to significantly impaired oxygen transport to the aneurysmal wall is supported and it is observed that ILT thickness and length are the parameters that influence decreased oxygen flow and concentration values the most, and thick thrombi exacerbate hypoxic conditions in the arterial wall, which may contribute to increased tissue degradation.
Abstract: The objective of this paper is to analyze the association of intraluminal thrombus (ILT) presence and morphology with oxygen transport in abdominal aortic aneurysms (AAA) and local hypoxia. The biomechanical role of the ILT layer in the evolution of the aneurysm is still not fully understood. ILT has been shown to create an inflammatory environment by reducing oxygen flux to the arterial wall and therefore decreasing its strength. It has been also hypothesized that the geometry of the ILT may further affect AAA rupture. However, no previous research has attempted to explore the effect of morphological features of ILT on oxygen distributions within the AAA, in a systematic manner. In this study, we perform a comprehensive analysis to investigate how physiologically meaningful variations in ILT geometric characteristics affect oxygen transport within an AAA. We simulate twenty-seven AAA models with variable ILT dimensions and investigate the extent to which ILT attenuates oxygen concentration in the arterial wall. Geometric variations studied include ILT thickness and ILT length, as well as the bulge diameter of the aneurysm which is related to ILT curvature. Computer simulations of coupled fluid flow-mass transport between arterial wall, ILT, and blood are solved and spatial variations of oxygen concentrations within the ILT and wall are obtained. The comparison of the results for all twenty-seven simulations supports the hypothesis that the presence of ILT in AAA correlates to significantly impaired oxygen transport to the aneurysmal wall. Mainly, we observed that ILT thickness and length are the parameters that influence decreased oxygen flow and concentration values the most, and thick thrombi exacerbate hypoxic conditions in the arterial wall, which may contribute to increased tissue degradation. Conversely, we observed that the arterial wall oxygen concentration is nearly independent of the AAA bulge diameter. This confirms that consideration of ILT size and anatomy is crucial in the analysis of AAA development.
TL;DR: Large transfusion protocols involving a 1:1:1 ratio of red blood cells:fresh frozen plasma:platelets has been recommended although further evidence is needed, and consideration must be taken for the side effects, including electrolyte imbalance and lung injury.
Abstract: Hemorrhagic shock has been studied extensively in the adult population, but evidence is lacking in the pediatric population. Unlike adults, pediatric patients tolerate hypovolemia with less hypotension until they have reached significant blood volume loss. It is imperative they receive prompt intravenous access, crystalloid resuscitation, followed by blood product transfusion. A hemoglobin goal of 7 g/dL has been translated to the pediatric population without evidence of poor outcomes. Massive transfusion protocols involving a 1:1:1 ratio of red blood cells:fresh frozen plasma:platelets has been recommended although further evidence is needed. With the transfusion of multiple blood products, consideration must be taken into account for the side effects, including electrolyte imbalance and lung injury.
TL;DR: The use of blood lactate monitoring has a place in risk‐stratification in critically ill patients, but it is unknown whether the routine use of lactate as a resuscitation end point improves outcome.
Abstract: Objective:To decide whether the use of blood lactate monitoring in critical care practice is appropriate. We performed a systematic health technology assessment as blood lactate monitoring has been implemented widely but its clinical value in critically ill patients has never been evaluated properly
TL;DR: The role of lactate as a biomarker in diagnosing and assessing the severity of systemic hypoperfusion, as well as the role of serum lactate measurements in guiding clinical care and enabling prognosis in critically ill patients are discussed.
TL;DR: It is concluded that plasma IL-6 levels predict mortality and that they are a useful tool to identify patients who are at risk for development of MODS.
Abstract: Background Although therapeutic concepts of patients with major trauma have improved during recent years, organ dysfunction still remains a frequent complication during clinical course in intensive care units. It has previously been shown that cytokines are upregulated under stress conditions such as trauma or sepsis. However, it is still debatable if cytokines are adequate parameters to describe the current state of trauma patients. To elucidate the relevance of cytokines, we investigated if cytokines predict development of multiple organ dysfunction syndrome (MODS) or outcome.
TL;DR: Pat-related factors such as age, loss of consciousness and haemoglobin predicts outcome in a population where both emergency OR and EVAR for the treatment of rAAA is feasible.